Nadine Chase Priyanka Patel Genus Mycobacterium Family Mycobacteriaceae

Nadine Chase & Priyanka Patel

� � Genus: Mycobacterium Family: Mycobacteriaceae Mycobacterium Leprae � Acid-fast Bacillus � Gram Positive � Bacillus shape � Single arrangement � Aerobic � Optimum growth temperature is 30° Trivia � Can not be grown in culture http: //asylumeclectica. com/asylum/malady/archives/leprosy 4. jpg

Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.

�Tuberculoid Leprosy �Pauci-bacillary (PB) Leprosy Well defined skin lesions that are numb 1 -5 skin lesions �Lepromatous Leprosy �Multi-bacillary (MB) Leprosy Chronically stuffy nose Many skin lesions and nodules >5 skin lesions

� Skin tissue � Peripheral nerves � Mucus membranes � Bacteria prefers outer cooler parts of the body Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.

�Widespread organism living in water and food sources �Obligate Parasites (cannot live independently) �Fish �Insects

�Not very contagious �Air born disease �Droplets discharged from the respiratory tract �Nasal secretions �Prolonged contact with excretions from lesions �Slow replication time �Long incubation period

� Affinity for macrophages and Schwann cells � In Schwann cell �Mycobacterium binds to the G domain of alpha chain of laminin 2 in the basal lamina �Stimulates cell mediated immune response which causes swelling, chronic inflammatory response �Ultimately leads to axonal (nerve) death http: //www. med. nyu. edu/news_and_views/images/leprosy. jpg

Normal Nerve Cell enlargement Arnold, Harry. Modern Concepts of Leprosy. Springfield, IL, 1953.

�Avoid contact with infected persons � 99% of the population have natural immunity http: //www. ruggedelegantliving. com/journal/images/2003/05/01/sars. mask. jpg

� Long incubation period � Skin lesions with decreased sensitivity � Numbness � Muscle weakness � Cosmetic Disfiguration � Death is usually caused by a secondary opportunistic disease http: //www. wrongdiagnosis. com/l/leprosy/deaths. htm

� Leprosy Skin Test �Inactive Leprosycausing bacteria injected into skin �Body will react to the Leprosy antigens �Check injection 3 days and 28 days later �Positive skin reaction is seen in Tuberculoid Leprosy only �Normal result: little to no skin irritation around injection site http: //www. nlm. nih. gov/medlineplus/ency/article/003383. htm

� Shave Biopsy �Least invasive �Superficial layers of lesion scraped off �No stitches required �Bacteria can be identified on a slide http: //www. nlm. nih. gov/medlineplus/ency/article/003383. htm

�Punch Biopsy �Small cylinder of skin removed �Sizes vary depending on size of lesion �May require stitches http: //www. nlm. nih. gov/medlineplus/ency/article/003383. htm

�Excisional Biopsy �Local anesthetic applied �Entire lesion is removed �Stitches are usually needed http: //www. nlm. nih. gov/medlineplus/ency/article/003383. htm

� Methacholine sweat testing �An intradermal injection of methacholine demonstrates the absence of sweating in leprous lesions. �Helpful to identify diagnosis when lesions are not visible on dark skin individuals Arnold, Harry. Modern Concepts of Leprosy. Springfield, IL, 1953.

� Multi-drug therapy � PB Leprosy �Two Drugs: Rifampicin and Dapsone for 6 months � MB Leprosy �Three Drugs: Rifampicin, Dapsone, Clofazimine for 12 months http: //www. nlm. nih. gov/medlineplus/ency/article/003383. htm

Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.

� Special Footwear to prevent foot ulcers Grunberg, E. , Babger, LF, et al. Leprosy. New York, 1951.

�Age �Children are more susceptible �Bimodal age distribution with peaks at ages 10 -14 and 35 -44 with higher susceptibilities in younger years �Sex �Higher infection rate in males compare to females �Ratio of infection is 2: 1

�Race �African blacks are highly susceptible to the tuberculoid form of leprosy �Caucasians and Chinese are more susceptible to the lepromatous type of Leprosy �Its more rural than urban disease in Asia and Pacific Basin

http: //tmcr. usuhs. mil/tmcr/chapter 34/large 34/34 -01. jpg

� � 2002 Data � 1, 000 deaths in North and South America 96 cases in the U. S � 3, 000 deaths in South East Asia � 1, 000 death in Eastern Mediterranean � 1, 000 deaths Western Pacific 2005 Data � 166 new cases were reported in U. S. � 60% of these cases occurred in: California Louisiana Massachusetts New York Texas

HANSEN DISEASE (LEPROSY) Number of reported cases, by year United States, 1973 -2003 www. cdc. gov/epo/dphsi/annsum/2003/slides/hansgraf. ppt

� Attempt to identify new drugs that can stop the neural damage caused by the bacteria � Bacteria needs to recognize certain type glycoprotein on the cell surface to bind with and subsequently enter the cell � If these glycoprotein can be identified and a drug can interfere with the binding between the bacterium and the protein, this could potentially prevent entry of the bacteria and stop neural damage

� Leprosy has been found to NOT be hereditary � If twin siblings become infected, the disease is passed from one to the other solely because of the proximity in which they live � Twin A acquired the disease at age 15 � Twin B at age 19 � The disease effects the twins differently

Twin A Twin B Chakravartti, M. R. and Vogel, F. A Twin Study on Leprosy. Germany, 1973.

� Arnold, Harry. Modern Concepts of Leprosy. Springfield, IL, 1953. � Chakravartti, M. R. and Vogel, F. A Twin Study on Leprosy. Germany, 1973. � Grunberg, E. , Babger, LF, et al. Leprosy. New York, 1951. � http: //www. cdc. gov/ncidod/dbmd/diseaseinfo/hansens_t. htm � http: //www. nlm. nih. gov/medlineplus/ency/article/003383. htm � http: //tmcr. usuhs. mil/tmcr/chapter 34/large 34/34 -01. jpg � http: //www. wrongdiagnosis. com/l/leprosy/deaths. htm � “Leprosy. “e. Medicine from webmed. http: //www. sunysccc. edu/academic/mst/microbes/16 mlepr. htm 21 July 2007. � “Leprosy, The Disease” World Health Organization; Regional Office for Southeast Asia. www. searo. who. int/En/Section 10/section 20/section 57_8963. htm. 22 December � Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.